HSE ‘at last’ finds place for brain-damaged homeless man in Mountjoy 

Prison governer disputes suggestion of neglect after report said feet not washed for a year 
 
A brain-damaged homeless man on remand in Mountjoy Prison’s high support unit for more than a year is expected to be moved to an appropriate care unit before Christmas, the president of the High Court has heard. 
The HSE has “at last” identified an appropriate place and made funding available for it, Mr Justice Peter Kelly remarked on Thursday. 
 
He directed the HSE to provide a sworn statement explaining its failure to advance a care plan for the man before now and before the High Court recently got involved in his situation. 
 
The judge last week directed the HSE and other parties be put on notice of the situation of the man. He was remanded in November 2018 by the District Court to Mountjoy on charges of alleged assault on two security guards who approached him when taking shelter in a women’s toilets in a Dublin shopping centre. A doctor who saw him just before he was taken to Mountjoy assessed him as unfit to plead. 
 
The High Court became involved after Dublin law firm ME Hanahoe, representing the man in the District Court case, raised concerns, in the context of possibly wardship, that Mountjoy is inappropriate for the man as a vulnerable adult with cognitive impairment. 
 
The judge was told the HSE appeared to have been aware for many months the man lacks capacity and is inappropriately placed. He was told a senior HSE official had cancelled a care plan devised by the Central Mental Hospital on the basis that resources were not available and it was proposed to discharge the man to access homeless services. 
 
Asking a vulnerable brain-damaged person to voluntarily access homeless services was an “impossibility”, Felix McEnroy SC, for the man, said. 
 
When the matter returned before the judge on Thursday for directions as to how it should progress, the HSE, Minister for Justice, Irish Prison Service and DPP were all represented. 
 
 
Shane Murphy SC, for the HSE, said the matter had transferred between different sections of the HSE and it would need time to provide an affidavit addressing what happened. The HSE’s priority now is to effect the man’s move to the identified placement, he said. 
 
The judge said the problem with the HSE is that it operates in “silos” with one silo apparently not communicating with the other. His immediate concern was the current situation but the HSE should address the historic situation where “little seems to have been done” by it despite knowing of his situation since perhaps last March and certainly since October when a report confirmed he has moderate/severe cognitive impairment. He accepted the HSE might not be in a position to provide that affidavit by next week’s hearing. 
 
Mr McEnroy said his side had been told the HSE has identified an appropriate care placement to which the man could be moved before the end of this law term on December 20th. 
 
“It seems that, at long last, the matter is going to move in the right direction.” 
 
The judge, noting the High Court cannot intervene in the criminal process, inquired about the position of the DPP. He was told it was likely, in the context of undisputed evidence the man is unfit to be tried, the DPP would ask the District Court next week to adjourn the criminal proceedings generally and not to seek a remand in custody. 
 
In those circumstances, Mr Justice Kelly said he could make a wardship order without interfering with the criminal process. The man will be put on notice of the intended wardship application and a guardian at litem will be appointed to represent his interests, including any objection to wardship. 
 
Counsel for the Minister for Justice and the prison service said the Governor of Mountjoy, Edward Mullins, had provided an affidavit addressing issues of the man’s care which put forward a “very different” view to that of the medical visitor. 
 
 
The medical visitor had said the man’s feet appeared to have remained unwashed for the year he was in Mountjoy, he appeared to have a toenail disease known as Ram’s Horn, where the nails grow very long and curl around and his bed linen appeared not to have been changed in months. 
 
In his affidavit, the Governor disputed any suggestion the man was neglected , saying he is reviewed twice weekly by the in-reach mental health team, is receiving appropriate medication and has had 124 medical interventions. 
 
The Governor said he understood the man changes his bed linen regularly and the medical visitor’s view might be due to the man letting cigarette ash accumulate on sheets. The man had had his feet treated by a chiropodist last January, refused to attend a chiropodist again in October and was treated by a chiropodist earlier this month. 
 
Counsel said the most recent report from the chiropodist referred to his feet being “very clean” and the man having very long, thick nails and an ingrown toenail condition, not Ram’s Horn. A prison doctor who examined the man on November 26th reported his feet were in very poor condition and he urgently required a chiropodist. 
 
Mr Justice Kelly said the medical visitor is very experienced and his concern was that vulnerable adults lacking capacity who may be unable to manage their personal hygiene should not be left to do so, especially in a medical unit. The feet issue had been partially addressed and the wider dispute about the man’s condition would be addressed at a later stage, he said. 
 
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